Provider Demographics
NPI:1750023123
Name:DENTAL SMILES FOR KIDS, LLC
Entity Type:Organization
Organization Name:DENTAL SMILES FOR KIDS, LLC
Other - Org Name:DENTAL SMILES FOR KIDS RONKONKOMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PARASKEVAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KOURTSOUNIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-451-7700
Mailing Address - Street 1:500 PORTION RD STE 216
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4587
Mailing Address - Country:US
Mailing Address - Phone:631-451-7700
Mailing Address - Fax:
Practice Address - Street 1:500 PORTION RD STE 216
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-4587
Practice Address - Country:US
Practice Address - Phone:631-451-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-07
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty